研究者詳細 - 塚原　紘平

論文 - 塚原　紘平

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Radiation in an emergency situation: attempting to respect the patient's beliefs as reported by a minor. 国際誌

Tetsuya Yumoto, Takashi Hongo, Yasuhiro Koide, Takafumi Obara, Kohei Tsukahara, Hiromichi Naito, Atsunori Nakao

BMC medical ethics 24 ( 1 ) 80 - 80 2023年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Each individual's unique health-related beliefs can greatly impact the patient-clinician relationship. When there is a conflict between the patient's preferences and recommended medical care, it can create a serious ethical dilemma, especially in an emergency setting, and dramatically alter this important relationship. CASE PRESENTATION: A 56-year-old man, who remained comatose after out-of-hospital cardiac arrest, was rushed to our hospital. The patient was scheduled for emergency coronary angiography when his adolescent daughter reported that she and her father held sincere beliefs against radiation exposure. We were concerned that she did not fully understand the potential consequences if her father did not receive the recommended treatment. A physician provided her with in depth information regarding the risks and benefits of the treatment. While we did not want to disregard her statement, we opted to save the patient's life due to concerns about the validity of her report. CONCLUSIONS: Variations in beliefs regarding medical care force clinicians to incorporate patient beliefs into medical practice. However, an emergency may require a completely different approach. When faced with a patient in a life-threatening condition and unconscious, we should take action to prioritize saving their life, unless we are highly certain about the validity of their advance directives.

DOI： 10.1186/s12910-023-00962-5

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補助検査として4vessel studyを行った法的脳死判定の1例

塚原紘平, 内藤宏道, 萩原万龍, 野島剛, 湯本哲也, 中尾篤典, 横田裕行

移植 58 ( 総会臨時 ) 249 - 249 2023年9月

An Unusual Presentation of Chest Pain and Laryngeal Discomfort in a Pregnant Woman: A Case Report and Literature Review.

Misa Sasanami, Atsuyoshi Iida, Masaya Iwamuro, Ryousuke Hirai, Takashi Obara, Kohei Tsukahara, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao

Acta medica Okayama 77 ( 4 ) 429 - 431 2023年8月

記述言語：英語

Intramural esophageal dissection (IED), characterized by bleeding into the submucosal space, leads to mucosal separation and dissection. The most prevalent symptoms are sudden chest or retrosternal pain, hematemesis, and dysphagia. Therefore, acute coronary syndrome and aortic dissection are among its most notable differential diagnoses. A 31-year-old pregnant woman presented with acute chest pain, laryngeal discomfort, and hematemesis. Emergency esophagogastroscopy revealed longitudinal mucosal dissection (upper esophagus to esophagogastric junction). The patient was successfully treated by avoiding the ingestion of solid foods. Clinicians should consider a diagnosis of IED for pregnant patients with acute chest pain, especially if hematemesis is present.

DOI： 10.18926/AMO/65755

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アセトアミノフェン中毒におけるプロカルシトニンの有用性

野島剛, 本郷貴識, 小原隆史, 小崎吉訓, 飯田淳義, 湯本哲也, 青景聡之, 塚原紘平, 内藤宏道, 中尾篤典

中毒研究 36 ( 2 ) 207 - 207 2023年7月

救急医療現場における個人的信念に基づく医療行為拒否への対応放射線被曝拒否事例から考える

小出恭大, 湯本哲也, 本郷貴識, 小崎吉訓, 野島剛, 上田浩平, 小原隆史, 飯田淳義, 山本浩継, 青景聡之, 塚原紘平, 内藤宏道, 中尾篤典

日本臨床救急医学会雑誌 26 ( 3 ) 358 - 358 2023年7月

レボチロキシン多量服薬の一例

小崎吉訓, 内藤宏道, 小出恭大, 塚原紘平, 湯本哲也, 中尾篤典

日本臨床救急医学会雑誌 26 ( 3 ) 351 - 351 2023年7月

救急医療現場における個人的信念に基づく医療行為拒否への対応放射線被曝拒否事例から考える

小出恭大, 湯本哲也, 本郷貴識, 小崎吉訓, 野島剛, 上田浩平, 小原隆史, 飯田淳義, 山本浩継, 青景聡之, 塚原紘平, 内藤宏道, 中尾篤典

日本臨床救急医学会雑誌 26 ( 3 ) 358 - 358 2023年7月

アセトアミノフェン中毒におけるプロカルシトニンの有用性

野島剛, 本郷貴識, 小原隆史, 小崎吉訓, 飯田淳義, 湯本哲也, 青景聡之, 塚原紘平, 内藤宏道, 中尾篤典

中毒研究 36 ( 2 ) 207 - 207 2023年7月

集中治療領域での嚥下障害

本郷貴識, 小原隆史, 野島剛, 上田浩平, 青景聡之, 塚原紘平, 湯本哲也, 内藤宏道, 中尾篤典

日本集中治療医学会雑誌 30 ( Suppl.1 ) S269 - S269 2023年6月

当科における小児急性脳症と体温管理療法の現状

小原隆史, 塚原紘平, 平岡知浩, 本郷貴識, 湯本哲也, 内藤宏道, 中尾篤典

日本脳低温療法・体温管理学会誌 26 ( 1 ) 47 - 47 2023年6月

つなぐ命と気持ち～脳死移植における集中治療の役割～潜在的なドナーの認知から移植外科医につなげるところまで終末期の児童に対し「臓器移植の情報提供」を含めた選択肢提示を行うために当院の体制作りと現状

塚原紘平, 小原隆史, 野島剛, 上田浩平, 本郷貴識, 小崎吉訓, 山本浩継, 飯田淳義, 青景聡之, 湯本哲也, 内藤宏道, 中尾篤典

日本集中治療医学会雑誌 30 ( Suppl.1 ) S331 - S331 2023年6月

小児の院外心停止における医師の病院前救急診療は神経学的転帰を改善する

小原隆史, 湯本哲也, 塚原紘平, 野島剛, 本郷貴識, 松本尚美, 頼藤貴志, 中尾篤典, 内藤宏道

日本集中治療医学会雑誌 30 ( Suppl.1 ) S422 - S422 2023年6月

つなぐいのち～小児脳死下臓器ドナー管理小児脳死下臓器ドナー管理の特徴当センターでの経験から

小原隆史, 内藤宏道, 塚原紘平, 野島剛, 上田浩平, 本郷貴識, 小崎吉訓, 山本浩継, 青景聡之, 湯本哲也, 中尾篤典

日本集中治療医学会雑誌 30 ( Suppl.1 ) S283 - S283 2023年6月

aEEGモニタリングが診断・薬物調整に有用であったFIRESの一例

小原隆史, 平岡知浩, 山本浩継, 塚原紘平

日本小児救急医学会雑誌 22 ( 2 ) 292 - 292 2023年6月

当科における小児急性脳症と体温管理療法の現状

小原隆史, 塚原紘平, 平岡知浩, 本郷貴識, 湯本哲也, 内藤宏道, 中尾篤典

日本脳低温療法・体温管理学会誌 26 ( 1 ) 47 - 47 2023年6月

Hydrogen inhalation attenuates lung contusion after blunt chest trauma in mice. 国際誌

Kohei Ageta, Takahiro Hirayama, Toshiyuki Aokage, Mizuki Seya, Ying Meng, Tsuyoshi Nojima, Hirotsugu Yamamoto, Takafumi Obara, Atsunori Nakao, Tetsuya Yumoto, Kohei Tsukahara, Hiromichi Naito

Surgery 2023年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Lung contusion caused by blunt chest trauma evokes a severe inflammatory reaction in the pulmonary parenchyma that may be associated with acute respiratory distress syndrome. Although hydrogen gas has antioxidant and anti-inflammatory effects and is protective against multiple types of lung injury at safe concentrations, the effects of inhaled hydrogen gas on blunt lung injury have not been previously investigated. Therefore, using a mouse model, we tested the hypothesis that hydrogen inhalation after chest trauma would reduce pulmonary inflammation and acute lung injury associated with lung contusion. METHODS: Inbred male C57BL/6 mice were randomly divided into 3 groups: sham with air inhalation, lung contusion with air inhalation, and lung contusion with 1.3% hydrogen inhalation. Experimental lung contusion was induced using a highly reproducible and standardized apparatus. Immediately after induction of lung contusion, mice were placed in a chamber exposed to 1.3% hydrogen gas in the air. Histopathological analysis and real-time polymerase chain reaction in lung tissue and blood gas analysis were performed 6 hours after contusion. RESULTS: Histopathological examination of the lung tissue after contusion revealed perivascular/intra-alveolar hemorrhage, perivascular/interstitial leukocyte infiltration, and interstitial/intra-alveolar edema. These histological changes and the extent of lung contusion, as determined by computed tomography, were significantly mitigated by hydrogen inhalation. Hydrogen inhalation also significantly reduced inflammatory cytokine and chemokine mRNA levels and improved oxygenation. CONCLUSION: Hydrogen inhalation therapy significantly mitigated inflammatory responses associated with lung contusion in mice. Hydrogen inhalation therapy may be a supplemental therapeutic strategy for treating lung contusion.

DOI： 10.1016/j.surg.2023.04.029

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新型コロナウイルス感染症の小児重症・中等症例発生状況(2022年上半期)

池山貴也, 井手健太郎, 岡田広, 賀来典之, 川崎達也, 黒澤寛史, 小泉沢, 齊藤修, 清水直樹, 竹内宗之, 武田充人, 田村卓也, 塚原紘平, 新津健裕, 三瓶智美, 清水一好, 辻尾有利子, 野坂クナウブ絵美里, 平井克樹, 日本集中治療医学会小児集中治療委員会日本小児集中治療連絡協議会新興再興感染症ワーキンググループ

日本集中治療医学会雑誌 30 ( 3 ) 202 - 207 2023年5月

記述言語：日本語出版者・発行元：(一社)日本集中治療医学会

日本集中治療医学会小児集中治療委員会による新型コロナウイルス関連小児重症・中等症例のオンライン登録システムでは,新型コロナウイルス感染症(COVID-19)の第6波において症例数が増加し,2022年1月から6月までの半年間に225例が登録された。第6波においては第5波では見られなかったCOVID-19関連クループが新たに報告され,登録症例の10%にのぼった。また,中枢神経系の異常を呈した症例の報告も14%から30%に増え,うち20%が小学生であることなど,臨床像に変化が見られた。本報告では第5波と第6波を比較してCOVID-19の臨床像について報告する。(著者抄録)

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Association of Prehospital Physician Presence During Pediatric Out-of-Hospital Cardiac Arrest With Neurologic Outcomes. 国際誌

Takafumi Obara, Tetsuya Yumoto, Tsuyoshi Nojima, Takashi Hongo, Kohei Tsukahara, Naomi Matsumoto, Takashi Yorifuji, Atsunori Nakao, Jonathan Elmer, Hiromichi Naito

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2023年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: To examine the association of prehospital physician presence with neurologic outcomes of pediatric patients with out-of-hospital cardiac arrest (OHCA). DESIGN: Retrospective cohort study. SETTING: Data from the Japanese Association for Acute Medicine-OHCA Registry. INTERVENTIONS: None. PATIENTS: Pediatric patients (age 17 yr old or younger) registered in the database between June 2014 and December 2019. MEASUREMENT AND MAIN RESULTS: We used logistic regression models with stabilized inverse probability of treatment weighting (IPTW) to estimate the associated treatment effect of a prehospital physician with 1-month neurologically intact survival. Secondary outcomes included in-hospital return of spontaneous circulation (ROSC) and 1-month survival after OHCA. A total of 1,187 patients (276 in the physician presence group and 911 in the physician absence group) were included (median age 3 yr [interquartile range 0-14 yr]; 723 [61%] male). Comparison of the physician presence group, versus the physician absence, showed 1-month favorable neurologic outcomes of 8.3% (23/276) versus 3.6% (33/911). Physician presence was associated with greater odds of 1-month neurologically intact survival after stabilized IPTW adjustment (adjusted odds ratio [aOR] 1.98, 95% CI 1.08-3.66). We also found an association in the secondary outcome between physician presence, opposed to absence, and in-hospital ROSC (aOR 1.48, 95% CI 1.08-2.04). However, we failed to identify an association with 1-month survival (aOR 1.49, 95% CI 0.97-2.88). CONCLUSIONS: Among pediatric patients with OHCA, prehospital physician presence, compared with absence, was associated almost two-fold greater odds of 1-month favorable neurologic outcomes.

DOI： 10.1097/PCC.0000000000003206

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Organ Donation after Extracorporeal Cardiopulmonary Resuscitation and Brain Death.

Takafumi Obara, Tetsuya Yumoto, Kenji Aoshima, Kohei Tsukahara, Hiromichi Naito, Atsunori Nakao

Acta medica Okayama 77 ( 1 ) 117 - 120 2023年2月

記述言語：英語

A 38-year-old primipara Japanese woman suffered cardiac arrest due to a pulmonary thromboembolism 1 day after undergoing a cesarean section. Extracorporeal cardiopulmonary resuscitation was initiated and extracorporeal membrane oxygenation support was needed for 24 h. Despite intensive care, the patient was diagnosed with brain death on day 6. With the family's consent, comprehensive end-of-life care including organ donation was discussed based on our hospital's policy. The family decided to donate her organs. Specific training and education are required for emergency physicians to optimize the process of incorporating organ donation into end-of-life care while respecting the patient's and family's wishes.

DOI： 10.18926/AMO/64372

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Successfully treated case of severe hypothermia secondary to myxedema coma. 国際誌

Hirotsugu Yamamoto, Takashi Hongo, Tsuyoshi Nojima, Takafumi Obara, Yoshinori Kosaki, Kohei Ageta, Kohei Tsukahara, Tetsuya Yumoto, Atsunori Nakao, Hiromichi Naito

Acute medicine & surgery 10 ( 1 ) e828 2023年

記述言語：英語

BACKGROUND: Myxedema coma is an extremely rare but fatal endocrine emergency that requires urgent recognition and treatment. We describe a case of severe hypothermia that rapidly deteriorated to cardiac arrest that was attributed to myxedema coma. CASE PRESENTATION: A 52-year-old man without a history of hypothyroidism was transferred to our emergency department due to coma and profound hypothermia. The patient developed cardiac arrest immediately after hospital arrival but return of spontaneous circulation was achieved shortly after resuscitation. The patient was noted to have generalized, nonpitting edema, dry skin, severe respiratory acidosis, hyponatremia, and elevated creatinine kinase, which was indicative of hypothyroidism. Myxedema coma was confirmed by a thyroid profile. The patient was successfully treated with intravenous levothyroxine and glucocorticoid. CONCLUSION: Although myxedema coma is a rare cause of severe hypothermia, emergency physicians should be familiar with its clinical features and management.

DOI： 10.1002/ams2.828

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